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A patient diagnosed with major depressive disorder will begin electroconvulsive therapy tomorrow. Which interventions are routinely implemented before the treatment?
- A. Administer pretreatment medication 30 to 45 minutes before treatment.
- B. Withhold food and fluids for a minimum of 6 hours before treatment.
- C. Remove dentures, glasses, contact lenses, and hearing aids.
- D. Restrain the patient in bed with padded limb restraints.
- E. Assist the patient to prepare an advance directive.
Correct Answer: A,B,C
Rationale: The correct interventions reflect routine electroconvulsive therapy preparation, which is similar to preoperative preparation: sedation and anticholinergic medication before anesthesia, maintaining nothing-by-mouth status to prevent aspiration during and after treatment, airway maintenance, and general safety by removing prosthetic devices. Restraint is not part of the pretreatment protocol. An advance directive is prepared independent of this treatment.
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A patient diagnosed with major depressive disorder was hospitalized for 8 days. Treatment included six electroconvulsive therapy sessions and aggressive dose adjustments of antidepressant medications. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling.
- A. Temporary memory impairments and confusion can be associated with electroconvulsive therapy.
- B. Antidepressant medications alter catecholamine levels, which impair decision-making abilities.
- C. Antidepressant medications may cause confusion related to a limitation of tyramine in the diet.
- D. The patient needs time to reorient him or herself to a pressured work schedule.
Correct Answer: A
Rationale: Recent memory impairment or confusion or both are often present during and for a short time after electroconvulsive therapy. An inappropriate business decision might be made because of forgotten and important details. The incorrect responses contain rationales that are untrue. The patient needing time to reorient himself or herself to a pressured work schedule is less relevant than the correct rationale.
A disheveled patient with severe depression and psychomotor retardation has not bathed for several days. What action should the nurse take?
- A. Avoid forcing the issue.
- B. Bringing up the issue at the community meeting.
- C. Calmly telling the patient, 'You must bathe daily.'
- D. Firmly and neutrally assisting the patient with showering.
Correct Answer: D
Rationale: When patients are unable to perform self-care activities, staff members must assist them rather than ignore the issue. Better grooming increases self-esteem. Calmly telling the patient to bathe daily and bringing up the issue at a community meeting are punitive.
The admission note indicates a patient diagnosed with major depressive disorder has displayed symptomology of both anergia and anhedonia. For which measures should the nurse plan?
- A. Channeling excessive energy
- B. Reducing guilty ruminations
- C. Instilling a sense of hopefulness
- D. Assisting with self-care activities
- E. Accommodating psychomotor retardation
Correct Answer: C,D,E
Rationale: Anhedonia refers to the inability to find pleasure or meaning in life; thus, planning should include measures to accommodate psychomotor retardation, assist with activities of daily living, and instill hopefulness. Anergia is the lack of energy, not excessive energy. Anhedonia does not necessarily imply the presence of guilty ruminations.
A nurse teaching a patient about a tyramine-restricted diet would approve which meal?
- A. Mashed potatoes, ground beef patty, corn, green beans, apple pie
- B. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
- C. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
- D. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls
Correct Answer: A
Rationale: The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine, and fresh ground beef and apple pie should be safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages and hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate.
A nurse provided medication education for a patient who is prescribed phenelzine for depression. Which patient behavior indicates effective learning?
- A. Monitors sodium intake and weight daily.
- B. Wears support stockings and elevates the legs when sitting.
- C. Consults the pharmacist when selecting over-the-counter medications.
- D. Can identify foods with high selenium content, which should be avoided.
Correct Answer: C
Rationale: Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.